Provider Demographics
NPI:1083877542
Name:BAKERSFIELD OUTPATIENT SURGERY CENTER LLC
Entity type:Organization
Organization Name:BAKERSFIELD OUTPATIENT SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL & MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:V
Authorized Official - Last Name:VERNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:661-865-4209
Mailing Address - Street 1:1404 FIELDSPRING DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3576
Mailing Address - Country:US
Mailing Address - Phone:661-858-0865
Mailing Address - Fax:661-858-0940
Practice Address - Street 1:201 CHINA GRADE LOOP
Practice Address - Street 2:SUITE C
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-1707
Practice Address - Country:US
Practice Address - Phone:661-340-9910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-04
Last Update Date:2008-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38144261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery